Provider Demographics
NPI:1205678083
Name:GREGORY, MARLIEN (PT)
Entity type:Individual
Prefix:
First Name:MARLIEN
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15605 SW SNOWY OWL LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8675
Mailing Address - Country:US
Mailing Address - Phone:503-969-7788
Mailing Address - Fax:
Practice Address - Street 1:501 N DIXON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1876
Practice Address - Country:US
Practice Address - Phone:503-916-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist